关节镜辅助下不同内固定方式治疗儿童胫骨髁间嵴骨折的疗效对比

Efficacy of arthroscopic treatment fracture of intercondylar eminence of tibia in children

摘要:

目的：回顾性分析开放手术及单纯微创关节镜辅助下治疗儿童胫骨髁间嵴骨折的临床疗效，评价手术方式的差异，为临床治疗提供帮助。方法：回顾性分析2007年3月至2018年9月，重庆医科大学附属儿童医院收治的42例胫骨髁间嵴骨折患儿。8例采用切开复位内固定；34例采用单纯关节镜微创手术下骨折复位及治疗，其中15采用空心螺钉内固定，6例采用可吸收软骨钉固定，13例采用克氏针固定。术后采取长腿石膏或支具固定4~6周，定期门诊复查及电话随访，根据Lysholm评分、膝关节屈伸活动度、膝关节稳定性评定疗效。结果：关节镜可吸收软骨钉组手术时间[(118.33±21.66） min]长于关节镜克氏针组[（81.54±37.78） min]及关节镜空心螺钉组[（83.33±35.74） min]（t=2.215，P=0.041；t=2.800，P=0.013）。关节镜组手术时间为（88.82±36.31） min，少于开放手术组手术时间的（105.00±41.14） min（t=-1.107，P=0.275）。关节镜下手术组平均出血量为（2.79±1.27） mL，少于开放手术组的（9.38±1.77） mL（t=-12.195，P=0.000），关节镜下3种固定方式手术出血量差异无统计学意义（F=0.054，P=0.948）。关节镜手术组末次随访Lysholm 评分[（97.53±3.11）分]高于开放手术组评分[（92.00±6.97）分]（t=2.193，P=0.061），关节镜下3种固定方式末次随访Lysholm评分差异无统计学意义（F=0.115，P=0.892）。全部患儿术后切口均一期愈合，术后3个月内均获得骨性愈合。末次随访时全部患儿前抽屉试验、Lachman试验均呈阴性。切开复位组有2例发生关节僵硬，关节镜克氏针组有1例发生关节僵硬，其余膝关节活动度正常。结论：关节镜辅助下微创治疗儿童胫骨髁间骨折可获得较好疗效，固定方式多样，经分析后我们认为空心螺钉治疗儿童髁间嵴骨折具有操作简单、固定可靠、创伤小、关节功能恢复快等优点，值得在儿童骨科中推广应用。

Abstract:

Objective：To retrospectively analyze the efficacy of arthroscopic treatment fracture of intercondylar eminence of tibia in children;to evaluate the difference of surgical methods and provide help for clinical treatment. Methods：Totally 42 pediatriccases of tibial intercondylar eminence fracture treated by arthroscopy or open reduction between March 2007 to September 2018 were retro－spectively analyzed. Eight patients were treated by open reduction（open reduction group），15 patients were treated with hollow screw internal fixation（hollow screw group），6 patients were treated with absorbable cartilage nail fixation（cartilage nail group），and 13 pa－tients were treated with Kirschner wire fixation（Kirschner wire group）. Long leg plaster or braces were used for fixation for 4 to 6 weeks after operation. Regular outpatient follow-up and telephone follow-up were conducted. The efficacy was evaluated according to Lysholm score，the flexion and extension of the knee，and knee stability. Results：The operation time of the arthroscopic absorbable cartilage nail group[（118.33±21.66） min] was longer than that of the Kirschner wire group[（81.54±37.78） min] and the hol－low screw group[（83.33±35.74） min]（t=2.215，P=0.041；t=2.800，P=0.013）. The operation time of arthroscopic group was （88.82±36.31） min，which was less than that of open reduc－tion group [（105.00±41.14） min]（t=－1.107，P=0.275）. The aver－age amount of bleeding in the arthroscopic operation group[（2.79±1.27） mL] was less than that in the open operation group[（9.38±1.77） mL] （t=-12.195，P=0.000）. There was no significant dif－ference in the amount of bleeding among the three different fixation methods under arthroscope（F=0.054，P=0.948）. The Lysholm score in the lastest follow-up of the arthroscopic group（97.53±3.11） was higher than that of the open group（92.00±6.97）（t=2.193，P=0.061）. There was no significant difference in Lysholm score between the arthroscopic group and the open reduction group（F=0.115，P=0.892）. All the children’s incisions were primary healing，and bony healing was achieved within 3 months. At the lastest follow-up，the anterior drawer test and Lachman test of these children were all negative. One child in Kirschner wire group had a knee stiffness，two children had knee stiffness in the open reduction group，while the others had normal mobility. Conclusion：Arthroscopy-assisted fixation with hollow screw，absorbable cartilage screw and Kirschner wire can all achieve good results in the treatment of tibial inter－condylar fractures in children. However，different internal fixation methods have their own advantages. We insist that hollow screw fix－ation for tibial Intercondylar eminence fracture in children has the advantages of simple proccedures，definite fixation，small trauma and quick recovery of the function of the knee. It’s an ideal method of treatment for the tibial intercondylar eminence fracture in children.